Centre for Research in Vascular Biology, APC Microbiome Ireland, University College Cork, Cork University Hospital, Cork, Ireland.
Obesity (Silver Spring). 2020 Jul;28(7):1191-1194. doi: 10.1002/oby.22843. Epub 2020 May 31.
Coronavirus disease 2019 (COVID-19), the worst pandemic in more than a century, has claimed >125,000 lives worldwide to date. Emerging predictors for poor outcomes include advanced age, male sex, preexisting cardiovascular disease, and risk factors including hypertension, diabetes, and, more recently, obesity. This article posits new obesity-driven predictors of poor COVID-19 outcomes, over and above the more obvious extant risks associated with obesity, including cardiometabolic disease and hypoventilation syndrome in intensive care patients. This article also outlines a theoretical mechanistic framework whereby adipose tissue in individuals with obesity may act as a reservoir for more extensive viral spread, with increased shedding, immune activation, and cytokine amplification. This paper proposes studies to test this reservoir concept with a focus on specific cytokine pathways that might be amplified in individuals with obesity and COVID-19. Finally, this paper underscores emerging therapeutic strategies that might benefit subsets of patients in which cytokine amplification is excessive and potentially fatal.
2019 年冠状病毒病（COVID-19）是一个多世纪以来最严重的大流行病，迄今为止已在全球夺走了超过 125000 人的生命。目前，有一些新的预测指标可以提示预后不良，包括高龄、男性、心血管疾病史，以及高血压、糖尿病等风险因素，最近又增加了肥胖。本文提出了肥胖与 COVID-19 不良预后相关的新的预测指标，这些预测指标超出了肥胖相关的更明显的风险，包括心血管疾病和重症监护患者的低通气综合征。本文还概述了一个理论机制框架，其中肥胖个体的脂肪组织可能成为病毒更广泛传播的储库，导致病毒脱落增加、免疫激活和细胞因子放大。本文提出了一些研究建议，旨在通过关注特定的细胞因子途径来验证这一储库假说，这些途径可能在肥胖和 COVID-19 患者中被放大。最后，本文强调了一些新兴的治疗策略，这些策略可能对某些细胞因子放大过度且可能致命的患者亚群有益。
